90-100666 MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
-FEDERAL WAY BUILDING PERMIT 941-1555
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PERMIT NO. 90-948M OWNER'S NAME JEROME BRONSON JOB ADDRESS 924 S 299 PT.
CONTRACTOR NORTHWEST USI ADDRESS 1908 S 341 PT. #9 FEDERAT, WAY CONT. PHONE 952-5433
CONT. REG. NO. NORTHUSIO1JJ 4 91 OWNER'S PHONE 839-6273 OWNER'S ADDRESS SAME
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL _ COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITS ) MULTI. ADD. SIGN GRADING OTHER MECHANICAL ONLY
TAX ACCOUNT NO. NA X LEGAL DESCRIPTION EXISTING HOUSE
ISSUED BY ET,T 7.ARF..TH SNYDER x '- DATE OF ISSUE C -.).5 4 v DATE OF APPLICATION 6/20/90
BUILDING INFORMATION
OENA OCCUPANCY NA TYPE OF CONSTRUCTION MF.CHANTCAT. ONT.Y BLDG. SQ. FT. NA
BACKS: FRONT NA SIDE NA REAR NA STORIES NA HEIGHT LIMIT NA
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PIPING 11 FT 2-00 BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR _ TANK(S)
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS HOT WATER HTR. 6,50 MISC.
RETURNED _
SINKS MISC. CONVERSION BURNER BASIC FEE 20_00
DISHWASHERS TOTAL FIXTURES NONE UNIT HEATER TOTAL MECHANICAL 28_50 AMOUNT NONE
VALUATION NONE
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE INSPECTION RECORD
MECHANICAL FEE $28_50
AL BLDG. FEES Water Line OK Mechanical Inspection Notes:
RT P/C FEE
SEPA REVIEW GAS PIPING OK Date By
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES MECHANICAL PERMIT
AMOUNT DUE $28.50 Account No. 010-000-322-10-004 Total Fee $ 2�- SZ Receipt No. I i 5D/77ci
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION URN'S, EQ BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET: / C
OWNER OR AGENT iljDATE ��
MECHANICAL PERMIT
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
PERMIT NO. OWNER'S NAME JOB ADDRESS
CONTRACTOR ADDRESS CONT. PHONE
CONT. REG. NO. OWNER'S PHONE OWNER'S ADDRESS
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITS ) MULTI. ADD. SIGN GRADING OTHER
TAX ACCOUNT NO. LEGAL DESCRIPTION
ISSUED BY DATE OF ISSUE Z -9 c-, DATE OF APPLICATION
BUILDING INFORMATION
ZONE OCCUPANCY TYPE OF CONSTRUCTION BLDG. SO. FT.
411
SET BACKS: FRONT SIDE REAR STORIES HEIGHT LIMIT
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PIPING FT. BOILER
RECEIVED
BATHTUBS LAUNDRY DRAINS COMPRESSOR TANK(S)
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS HOT WATER HTR. MISC.
RETURNED
SINKS MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS TOTAL FIXTURES UNIT HEATER TOTAL MECHANICAL AMOUNT
VALUATION
GAS PIPING TEST MUST BE WITNESSED BY INSPECTOR. AFFIDAVIT WILL NOT SUFFICE.
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE INSPECTION RECORD
MECHANICAL FEE ��....N-L,
BLDG. FEES Water Line OK _ Mechanical Inspection Notes:
PART P/C FEE
SEPA REVIEW GAS PIPING OK Date -�G�n
`' `7
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
OTHER FEES MECHANICAL PERMIT
AMOUNT DUE Account No. 010-000-322-10-004 Total Fee $ Receipt No.
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
OWNER OR AGENT DATE
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REcEiVii CITY OF FEDERAL WAY
CrryOF z.0 � 0 BUILDING PERMIT APPLICATION
BUILDINGDU�I WAY - Please Print—
DEpT
BOX 1 TENANT NAME:
OWNER 1 gu ,PA11._ �` SITE LOCATION /Z°r S. 1 (—
OWNER'S ADDRESS '1 'M' _ �:� IT/Y�f�E a( i.✓� PHONE i-2 7,3
DESCRIBE JOB r "L KE � G 4-1,41- df ti-44,171-
THE PROPERTY IS OWNED BY: SINGLE/MARRIED _PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME /lle.crit v(n 2 as f CONTRACTOR'S REG. #:-'a./ HGAir%/J. I
Card MUST be presented
CONTRACTOR'S ADDRES 19 c) S 34-1 it(aL_ CITY ��26 iY. lid!J PHONE QST- Sri 3 3
EXPIRATION DATE 4579/
— OR —
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON /J /NIS Zai /.d PHONE C�S Z —`-)q _•-;.. 3-
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION /c_/,(757.//,'G— ,z'S
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( - ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET // / $
BATHTUBS NO. FURNACE, ELEC. GAS $
SHOWERS i GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
SINKS BOILER, SIZE BTU $
DISHWASHERS AIR HANDLING UNITS $
ELECTRIC HOT WATER HEATER HEAT PUMPS, SIZE $
LAUNDRY WASHER OUTLET UNIT HEATERS $
URINALS AIR COOLING UNITS, SIZE $
DRINKING FOUNTAINS COMMERCIAL HOOD $
SUMPS, SPRINKLER VACUUM BREAKERS OTHER $
DRAINS $
OTHER $
TOTAL FIXTURES $
TOTAL MECHANICAL FEE $
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE.I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM(INCLUDING COSTS,EXPENSES,AND ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE CITY OF FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES, UPON.THE A U,CY OF THE INFORMATION SUPPLIED TO THE CITY AS A
PART OF THIS APPLICATION.
OWNER/AGENT: 4 t..-- DATE: / 7
ANP-008 3/90